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You take my pointing out the hypocrisy of the left to mean that I support the right, when I support NEITHER. And my thought process in the political realm may be in the minority on this forum but it is where a large chunk of Americans fall.

Nope. I just do not believe that the "large chunk" of Americans are right. If that includes you that is your choice.

As for "who is working for a single payer system" -- the answer is simple -- almost no one. If the Dems really wanted it -- we would have had it when they controlled Congress with 60 Senators back in 2009. Ah yes, lobbyists do tend to throw money at the party in power and money does talk to both parties.

What I find more unfortunate is that you and I are far closer to each other on many topics than I am to the far right, but you seem only to focus on how we are different. Even when we agree you use it as a way to denigrate my position.

I agree we are far closer to each others positions but you have the notion that compromise and being "in the middle" is a solution. Should we "compromise' on gay rights? Women's rights? Human "rights" ? Sometimes you just have to put the blame on who is trying to prevent progress and forward thinking from occurring and you keep talking compromise. Compromise is NOT always the solution. I know you believe this but I do not. That is where we differ and that has always been the focus of our discussions. I just wish that you could get beyond that concept but I'm not sure if you can. I know your heart is the right place but by naming 3 or 23 Republicans out of nearly 300 means little to me and more importantly it means little to those who suffer in the mean time. Compromise? With what?

Yes -- I think a Single Payer System is what we need, but there is not enough support on either side for it to happen. The one place we consistently differ is that I don't view the Republicans, in general, as evil -- though I haven't voted for one since I left New England. I respect your position, but I just can't always let one-sided posts go by without giving my thoughts. BTW - William Weld, Claudine Schneider -- two Repubs with empathy and compassion who have gotten my votes in the past. Even Christie has his moments -- like when he put politics on the back burner after Sandy and actually talked and thanked Obama for helping the victims in his state. Not that I am a big Christie fan -- but he has shown empathy and compassion and deserves to get credit for it. Olympia Snowe, Susan Collins also come to mind, I'm sure with time I can come up with more.

If you are all for a single payer system which I believe you are I would only hope that some day soon you will see that, in general, the Republican party has been obstructing this concept for decades upon decades along with the previously mentioned rights of others. MUCH more vile (and yes, evil) lately without shame. It is not just a few but the vast majority of the GOP and it saddens me to even have to have this conversation with an HIV+ gay man in 2013.

Rosa Parks stood up against "mental midgets" and turned the tide for all of us. I'm just trying to do the same without defending the people who by all of their actions and deeds prevent human understanding and progress.

The so called "middle" is a place I could only be when rational thinking comes from both sides.

Should we have compromised or been in the middle when it came to fighting for our lives with the government no matter what political color the pushback was coming from? hmm....

Anyway -- I'm sorry you don't like our political discussions -- I always find them interesting, I mean if people with differing views don't even like to discuss them, we'll never get anywhere, because I'm not always right -- but I'm not always wrong either.

Hugs,Mike

I'm sorry too. We both have similar beliefs in many ways as to what needs to happen but our ideas in how to get there are at opposite sides of the room and I don't think that will change.

I still think the world of you if it matters. If I didn't care about you I would not have spent this much time and effort to respond at this late hour.

Your filibuster comment is an example of why I mentioned that you seem to be reading to refute (don't mean to be condescending at all) -- there was no threat of a filibuster back then -- there were 60 Dems in the Senate, right up until Ted Kennedy's death.

As for Compromise -- yes -- it is the path and has always been the path, in my opinion. Your stance that compromise is a bad thing mimics the Tea Party and I know you are no fan of that group. And yes -- compromise on Gay Rights is what has been happening -- do I wish we could just get to equality, yes I do, but it is not feasible. Right now we can marry in 16 states -- that "compromise" is better than going for the holy grail and ending up with a US Constitutional Amendment banning it.

And to be clear -- you seem to be thinking that by not agreeing with your side that I am agreeing with the other -- I am not. We once had a farther right person on here -- I forget his name now -- I had a couple of these conversations with him too. (although I had little respect for him, so didn't bother too much)

I do agree that the middle requires rational thinking -- from BOTH SIDES. I know you think the left is much more rational than the right. I'm not sure I agree -- there is heel digging on both.

Bottomline for me -- compromise get progress more than "purity", though there are times when one must hold fast to principle -- I do agree with that.

At any rate -- I agree with most of what you say -- we do just see different paths to get there. By talking about it, hopefully we learn a little about why we think that way -- I'm not really looking to change your mind, just to help you see where I am coming from and I get to see where you are coming from.

according to data from 2002 - 2013:72 million - Democrat55 million - Republican42 million - Independent

when you figure some of the Independents would side Democrat - clearly we a more blue nation

Moderates exist in all three groups -- so your conclusion is a little flawed -- there are "shades" of blue and "shades" of red. Think Cruz vs. Collins -- very different shades of Red. Baucus vs. Pelosi -- very different shades of blue.

Well I finally got enrolled in a plan I think I can live with for $54.00 per month. I gave up on the healthcare website after days of BS in Oct. So if all the paperwork comes through and payment is made I should be good hopefully. I am scared to death to go without ADAP and Ryan White. But I guess its time to see what happens, those 5 hour waiting periods in the health clinic are getting gruesome.

Well I finally got enrolled in a plan I think I can live with for $54.00 per month. I gave up on the healthcare website after days of BS in Oct. So if all the paperwork comes through and payment is made I should be good hopefully. I am scared to death to go without ADAP and Ryan White. But I guess its time to see what happens, those 5 hour waiting periods in the health clinic are getting gruesome.

Thanks for the post! I hope others, many others in the months to come share their experiences good or bad.

The nationís new health-care law says insurers canít turn anyone away, even people who are sick. But some companies, patient advocates say, have found a way to discourage the chronically ill from enrolling in their plans: offer drug coverage too skimpy for those with expensive conditions.

Some plans sold on the online insurance exchanges, for instance, donít cover key medications for HIV, or they require patients to pay as much as 50 percent of the cost per prescription in co-insurance ó sometimes more than $1,000 a month...

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I'm sure this has been already mentioned, but I think it's worth repeating. I talked to my case manager this morning and since I qualify for Ryan White/ADAP they will pay my insurance premium and meds. I'm enrolled in a silver plan through Blue Cross. My premium is very affordable but the cost of my meds before I met my deductible would have been expensive. if you think you qualify you should really check this out.

I'm sure this has been already mentioned, but I think it's worth repeating. I talked to my case manager this morning and since I qualify for Ryan White/ADAP they will pay my insurance premium and meds. I'm enrolled in a silver plan through Blue Cross. My premium is very affordable but the cost of my meds before I met my deductible would have been expensive. if you think you qualify you should really check this out.

I believe that is a state by state issue. When we went for the training in Indianapolis a couple months ago, we were told adap would not pay for the premiums, and if any of our clients who receive insurance through ISDH (state dept of health who administers adap), signs up through the insurance exchange, they would be dropped by the state's insurance. Just want people to verify this through their own state program.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

The nationís new health-care law says insurers canít turn anyone away, even people who are sick. But some companies, patient advocates say, have found a way to discourage the chronically ill from enrolling in their plans: offer drug coverage too skimpy for those with expensive conditions.

Some plans sold on the online insurance exchanges, for instance, donít cover key medications for HIV, or they require patients to pay as much as 50 percent of the cost per prescription in co-insurance ó sometimes more than $1,000 a month...

Hey All - I think this would be a better headline here. Not scary but informative. It's nothing new to be offered different tiers of coverage at different prices. I'm no fan of insurance companies but you have to make informed decisions and be familiar with the terms like "out of pocket costs", deductibles, drug tiers, co pays. None of these are were invented yesterday. If you are buying insurance for the first time get assistance. Speak to a couple of different insurance companies and write things down.

If you want the convenience of once a day dosing be prepared to pay for it. Sure it's more convenient. But if you can take two pills a day and save $300 a month you need to be able to weigh the pros and cons. From the little research I've done on The Affordable Care Act it looks like a person who is HIV should enroll in a Gold or Platinum plan unless they have a lot of cash in hand or other coverage. BUT - I'm not an advocate or YOU. Be familiar with all the terms and then make an informed decision.

I'm not looking to open a subthread here. Insurance is not a new product. It is an expensive one and for now we have to work within the parameters of the new law. Everyone needs it but needs to be sure they obtain the policy that best fits their needs.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

The deadline is looming to be covered by a new ACA plan by January 1st. Anybody have good or bad news to share?

( still wondering if Will found it beneficial. )

Well, heh, we have to get all our clients, who are currently on ichia (which will be phasing out), applied to the exchange when we get back to work. I mean the first week, we have to have all applications to the state by 01/10/13. The original plan was for the state to roll people into insurance, but since there are seven, with a shitload of different plans, we have to figure it out. Not something I look forward to.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Well, heh, we have to get all our clients, who are currently on ichia (which will be phasing out), applied to the exchange when we get back to work. I mean the first week, we have to have all applications to the state by 01/10/13. The original plan was for the state to roll people into insurance, but since there are seven, with a shitload of different plans, we have to figure it out. Not something I look forward to.

I don't envy you Betty. It's a huge change in so many ways and the planning was not executed well. Once the dust settles I hope your clients benefit.

I have medicare. I can't afford to go to all of the specialists my doctor sends me to because of the 20% co-pay and my health is suffering because of it. I can't afford to buy a health plan. Is there any help for me? I make over the cutoff for medicaid. I applied for Medicaid "spend down" and I was denied but told if I rack up over $1014 IF medical bills I may be eligible for the "spend down".. Is there no other help?? The local ASO doesn't seem to be aware at all of any help I can get.

I have medicare. I can't afford to go to all of the specialists my doctor sends me to because of the 20% co-pay and my health is suffering because of it. I can't afford to buy a health plan. Is there any help for me? I make over the cutoff for medicaid. I applied for Medicaid "spend down" and I was denied but told if I rack up over $1014 IF medical bills I may be eligible for the "spend down".. Is there no other help?? The local ASO doesn't seem to be aware at all of any help I can get.

Some times a medical provider has programs or compassionate care programs that you can apply for that can drastically cut your doctor bills and sometimes eliminate them . When I was in chemo therapy and had Medicare only so the facility wrote off my 20 % , which was a considerable amount .

Actually my best friend's daughter and son-in-law were able to get signed up for a plan (for the two of them, their children are on Medicaid), for $34/month; the daughter is the only one working, as the son-in-law just lost his job right before Christmas.

Living,Jeff is correct, many doctor's offices have a financial aid assistance that can help greatly with co-pays. Also, many doctors will write off what Medicare doesn't pay. What about your meds? Are they taken care of?

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

I guess I'm one of the really lucky ones. I was able to navigate the website and sign up for a plan I like through Blue Cross. I have been under Ryan White for the past ten years. I went in to talk to my case manager because I wanted to make sure I would be able to get my meds for December while waiting for my insurance coverage. Totally surprised to find out that the state of TN is going to pay for my insurance because I qualify for Ryan White. Premium, deductible, the whole nine yards. I know it varies state to state but I would advise anyone to check with their ASO or case manager to see what help is available. Thanks Obama!

I'm glad people are able to get signed up for this. Here in Hoosierville, it's not that simple.

We had a webinar right before Christmas, letting us know there will be 7 (now they say eight) plans to choose from. We were supposed to get a "widget" that would let us search by county of residence, doctor, meds etc. We were supposed to get this widget last week. As of today, nothing. Also, we have been closed because of the weather and will be tomorrow. For people's insurance to start 03/01, we needed to have the apps to Indiana State Dept of Health for final approval (they are paying everything for the clients), in two days (01/10).

So, I have been working from home, calling clients because I also found out that we can also get apps for clients in by 03/10 for insurance to start 04/01. In the meantime, we were told to contact the insurance carriers to find out if people's doctors/meds are covered. So, I started with Anthem. Talked to one of the agents. She searched for the doctor's name I gave her, which many of our clients see. She found his name, but told me he is not accepting plans through the exchange. WTF? Now what?

Of course I can't talk to my boss and I bet she has no idea about this. Not sure how this is going to play out.

In the meantime, when the insurance the clients are currently on (ichia) runs out, clients will be covered by adap/eip until the new insurance starts, or indefinitely. This also covers vision and dental. But, it does not cover emergency room visits or hospital stays. But will cover everything else.

I've been contacting clients, and one of them cussed me up and down as I was trying to explain "how" the insurance is going to change. That's nice, I'm working from home, and he was screaming at me because we haven't been open and he has to work etc. etc. etc.

I'M FRUSTRATED!

Edited to add: Since the announced changes to the insurance, the head of the insurance department at Indiana State Dept of Health resigned; last week the head of the whole care coordination dept at ISDH resigned. I think something is happening, just don't know what.

« Last Edit: January 07, 2014, 03:37:37 PM by BT65 »

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

I'm glad people are able to get signed up for this. Here in Hoosierville, it's not that simple.

We had a webinar right before Christmas, letting us know there will be 7 (now they say eight) plans to choose from. We were supposed to get a "widget" that would let us search by county of residence, doctor, meds etc. We were supposed to get this widget last week. As of today, nothing. Also, we have been closed because of the weather and will be tomorrow. For people's insurance to start 03/01, we needed to have the apps to Indiana State Dept of Health for final approval (they are paying everything for the clients), in two days (01/10).

So, I have been working from home, calling clients because I also found out that we can also get apps for clients in by 03/10 for insurance to start 04/01. In the meantime, we were told to contact the insurance carriers to find out if people's doctors/meds are covered. So, I started with Anthem. Talked to one of the agents. She searched for the doctor's name I gave her, which many of our clients see. She found his name, but told me he is not accepting plans through the exchange. WTF? Now what?

Of course I can't talk to my boss and I bet she has no idea about this. Not sure how this is going to play out.

In the meantime, when the insurance the clients are currently on (ichia) runs out, clients will be covered by adap/eip until the new insurance starts, or indefinitely. This also covers vision and dental. But, it does not cover emergency room visits or hospital stays. But will cover everything else.

I've been contacting clients, and one of them cussed me up and down as I was trying to explain "how" the insurance is going to change. That's nice, I'm working from home, and he was screaming at me because we haven't been open and he has to work etc. etc. etc.

I'M FRUSTRATED!

Edited to add: Since the announced changes to the insurance, the head of the insurance department at Indiana State Dept of Health resigned; last week the head of the whole care coordination dept at ISDH resigned. I think something is happening, just don't know what.

Betty,

I feel your frustration!!

All I know is that it takes people like yourself to help those who are unable to navigate through the system. You really are making a difference. I hope you get thanked on a daily basis.

Thanks, Mitch. I feel I need to get out. I really feel it is getting to the point where they are trying to push people out of care. Something weird is happening, and I don't know what it is. But, I need to get out....

Sometimes I get thanked. I'm not narcissistic, I don't believe I'm the glue holding the clients to the agency lol, but it's nice when a client thanks me.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Sometimes I get thanked. I'm not narcissistic, I don't believe I'm the glue holding the clients to the agency lol, but it's nice when a client thanks me.

I bet you're the glue more often that you give yourself credit for. I was reading a study on how clients become lost to care recently and one of the factors listed was (particularly otherwise vulnerable) clients not feeling respected by, listened to or cared about by those handling their case. I don't remember which study had that little gem hidden in it, I read several.

I know you listen and I know you care, so who knows how many of your clients may have given up if faced with a case worker who obviously wasn't really listening and didn't really give a shit. We've all come up against people like that in the so-called "caring" professions and some people (clients) just can't cope with it.

As for the other stuff, it certainly sounds like the shit is going to hit the proverbial fan in Indiana with those resignations. Something is definitely amiss. Wonder if Obama knows what's going on in the Hoosier State? Maybe someone should drop him a line.....

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

That's an overly broad interpretation of what the articles actually says.

There are certainly some loopholes that need to be plugged. But for the overwhelming majority of people with HIV the ACA is a godsend. Including the 26,000 getting coverage through Medicaid expansion.

From the article;First and overriding, health care reform as a whole, with all of its troubles and everything, is a huge step forward for folks with HIV,Ē she says. ďAnd so now our work is to bring it home and do all the changes that need to happen in order to make it really work.Ē

Remember, before the ACA it was virtually impossible for someone with HIV to get an individual policy, let alone one at an "affordable" price.

HIV isn't cheap. If you have an expensive chronic disease, a bronze plan probably isn't going to work for you.

It's easy to foresee how the cost of meds is going to become, if it isn't already, one of many factors in determining which meds to choose (i.e. soon to be generic Sustiva & Truvada can be just as effective as Atripla, at a much lower cost). Will treatment inexperienced patients, with no resistance issues, be started on something like Stribild ($28,000 annually) right off the bat, when something much cheaper and just as effective will work for them? Like it or not, that may be the way things are heading.

« Last Edit: March 02, 2014, 09:51:30 AM by bmancanfly »

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"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

It's easy to foresee how the cost of meds is going to become, if it isn't already, one of many factors in determining which meds to choose (i.e. soon to be generic Sustiva & Truvada can be just as effective as Atripla, at a much lower cost). Will treatment inexperienced patients, with no resistance issues, be started on something like Stribild ($28,000 annually) right off the bat, when something much cheaper and just as effective will work for them? Like it or not, that may be the way things are heading.

i ask out of ignorance. is that a bad thing? much cheaper and just as effective, why not use it? i personally don't need to feel like i'm getting cavier when the kabob do just fine. all i want is my VL controlled.

I'm not personally making a value judgment. It's neither a good thing or a bad thing, it's just a thing.

It does seem an inevitability that for-profit insurance companies will be moving toward a tiered system for HIV drugs as more and more drugs become available in generic form.

FWIW I am on Viramune which was approved in'95 (or '96?). I have an undetectable VL and no side effects plus my copay with this drug is so low there was no motivation to switch to one of the newer meds with a higher copay.

Others, for a multitude of reasons, may make different choices. But I think the days of putting everyone on the "latest and greatest" meds, irrespective are cost, are numbered.

« Last Edit: March 02, 2014, 11:41:45 AM by bmancanfly »

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"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

i ask out of ignorance. is that a bad thing? much cheaper and just as effective, why not use it? i personally don't need to feel like i'm getting cavier when the kabob do just fine. all i want is my VL controlled.

My doc also likes to follow this philosophy, but more because it leaves more options open in the future if you have failure of one regimen. In addition to VL, drug resistance, and side effects, I'd add that keeping CD4 above 500 should be a goal as well, especially given the long term mortality numbers in the study below from both HIV and non-HIV causes for those who don't achieve CD4 recovery above 500 even with viral suppression.

Some of the OCA plans are crap for anyone with ongoing medical needs, really more akin to catastrophic coverage, bu at least with a $6,350 out of pocket max now. But the reality for most OCA plans is that for HIV treatment you'll be hit either quickly, or by the end of the year, with the out of pocket limit, plus the plan costs for the year, about 10k in total for plans I've helped friends look into. So without Ryan White, Fed assistance or medicade etc. it's still not affordable for many. Compared to employer plans where many people may have to pay $100ish a month for Rx co-pays without mfg assistance, and the monthly cost may be 0 or low for the employee, there is still a way to go.

My doc also likes to follow this philosophy, but more because it leaves more options open in the future if you have failure of one regimen. In addition to VL, drug resistance, and side effects, I'd add that keeping CD4 above 500 should be a goal as well, especially given the long term mortality numbers in the study below from both HIV and non-HIV causes for those who don't achieve CD4 recovery above 500 even with viral suppression.

12% mortality over 5 years for those with CD4 < 200 vs. 2% of those with CD4 above 500, all of whom had complete viral suppression. Last bit of the article below. If my CD4 was < 500, I'd work on getting it up via Fuzeon, a PI, or anything else my doc could recommend.

Edit: removed junk, misread the initial comment from Zach that buginme2 was replying to

"FUZEON blocks HIV's ability to infect healthy CD4 cells. When used with other anti-HIV medicines, FUZEON can reduce the amount of HIV in the blood and increase the number of CD4 cells. This may keep your immune system healthy, so it can help fight infection."

"KALETRA is used with other anti-HIV-1 medicines to increase the chance of treatment response in people with human immunodeficiency virus (HIV-1) infection. KALETRA:Blocks HIV-1 protease, a chemical that is needed for HIV-1 to multiplyReduces the amount of HIV-1 in the bloodIncreases the CD4 cell (immune cell) count in the blood"

both quotes taken directly from the manufacturer's websites. so is this an actual claim that these drugs raise CD4, or that by suppressing HIV replication, CD4 will as a byproduct of that, rise?

For what it's worth, my cd4 count shot up significantly when I went on Fuzeon and Prezista simultaneously, and my doctor had me wait to go on Fuzeon an extra year or more until I could get in a Prezista clinical study because he thought it would work better synergystically. I'm meaning from ~600 to ~900 fairly quickly.

ON THE OTHER HAND a friend of mine who started Fuzeon with much lower numbers of ~200 only had his go up by 50, so I would hesitate to make the claims that some are making below. It's possible, but far far from guaranteed.

ps: you inject Fuzeon twice daily, to three times. And unless you have documented multi-class resistance issues you're not going to get approved for Fuzeon. It costs something like $45,000 year alone.

Yeah, I agree Miss P, that's the problem with anecdotal evidence. I did look at a couple of Fuzeon links out of curiosity, and what your friend saw seems more in line, but those studies were all with patients who still had detectable viral replication going on too and Fuzeon is used on top of PI/NRTIs. Thanks for the cost info.

It would be nice to see some studies focusing on managing CD4s up in the cases of those with UD/low VL and poor CD4 counts. The morbidity numbers based on all of cohorts involved in the earlier link could also be reinforced or not...